Provider Demographics
NPI:1710382809
Name:HOIDA, BETSY (PHARMD)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:HOIDA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:JACOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1079 SPRINGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-7620
Mailing Address - Country:US
Mailing Address - Phone:616-644-4695
Mailing Address - Fax:
Practice Address - Street 1:2485 GREENBRIER RD.
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311
Practice Address - Country:US
Practice Address - Phone:920-288-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI154361835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy